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2011 Research and EPB projects

Vivian Low and Karen Halverson

Vivian Low, MPH, BSN, RN-BC and Karen Halverson, MLIS

PICO question:"What is the effect of a two-year strategic EBP initiative on nurses’ confidence and knowledge related to the conduct of quality improvement projects and research?"

The Nursing Research Council worked in collaboration with Kathleen R. Stevens, EdD, RN, FAAN, Academic Center for Evidence-Based Practice, The University of Texas Health Science Center , San Antonio, Texas. Our goal was to improve environment and culture to support bedside nurses obtaining skills to become quality investigators through a strategic education plan, and to assess our progress. Our hypothesis was that availability of EBP resources and educational interventions would enhance nurses’ willingness and capacity to conduct rigorous quality research over a two year time frame. Our health resource librarian was a key partner. Our measurement tool was the Academic Center for Evidence Based Practice (ACE) EBP Readiness Inventory (ERI). The results showed Nurses gained higher self confidence in primary research competencies. Positive empowerment and organizational commitment to Magnet EBP culture had a measureable impact on nurses’ self perception and knowledge of basic EBP skills.


Suanne Schutt

Suann Cirigliano Schutt, MS, RN-BC, CEP

PICO question: "Can an exploration of best practice strategies to maintain quality patient care and safety in the elderly population result in improved patient care and a reduction of hospital expenditures?"

A Constant Observation Task Force was created to maintain quality patient care and safety, while reducing hospital expenditures for the use of Patient Safety Attendants. Through the efforts of this committee, six-figure financial savings were realized for the hospital in the first six months alone. The committee achieved these results by staying focused on the paramount concern in today's healthcare culture; demonstrating financial savings without compromising patient safety.

The task force also worked on incorporating best practices for assessment of acute delirium into our existing computer-based system. With the completion of the Confusion Assessment Model (CAM), there is early identification of delirium for all hospitalized elderly patients. This assessment allows for early risk screening and implementation of a plan of care for acute delirium thus improving patient safety. The Constant Observation Task Force was able to create an innovative and effective system to manage care for acute delirium. Though originally a unit-based project, the new system is now implemented hospital-wide.


Sepsis Committee

Kelly Nguyen, MS, RN (left); Laura Cook, MD (front); and Joan Santana, RN, BSN

PICO question: "Will the incremental implementation of a set of evidence-based therapies by bedside clinicians throughout the ED, CCU, PCU, telemetry and medical-surgical units yield a positive impact on patients with varying degrees of sepsis?”

The Sepsis Campaign at El Camino Hospital is an ongoing endeavor to sustain a mortality rate at or below national benchmarks utilizing a bundle of evidence-based practice interventions. To date we have achieved remarkable results through the utilization of a team approach, bedside clinician expertise, a standardized testing method (PDSA Cycle) and quality research practices. As a direct result of the campaign we have achieved a 40 percent relative reduction in the mortality rate for patients with severe sepsis and septic shock--which accounts for over 900 lives spared. The efforts of both the Sepsis Champions and the bedside staff maintain sustainability of this project and we continue to strive to identify alternative methods to enhance our performance in this realm.


Rebecca Loftus  MSN, RNCC, CNS and Margie Kunz, MSN, RNCC, CNS

Rebecca Loftus, MSN, RNCC, CNS and Margie Kunz, MSN, RNCC, CNS

PICO Question: "Would a retrospective chart review and concomitant analysis of fetal monitor strips using established criteria for identifying UT, demonstrate an occurrence above 30 percent and thereby provide an opportunity to improve care to the obstetric patient and her fetus?"

The purpose of this study was to determine the occurrence of uterine tachysystole (UT) in patients being induced with oxytocin. By increasing the understanding of the physiological basis of labor and the role which oxytocin plays, the Labor and Delivery nurse will be better able to work with the laboring woman to achieve birth. The results of this qualitative, retrospective, descriptive study showed an incidence above 30 percent in a convenience sample of 55 patients. We hope to contribute to the health and safety of obstetrical patients and resultant health of newborns by adding to the body of knowledge on uterine tachysystole (UT). We have appreciated all the support that El Camino Hospital, the Institutional Board of Review and the Nursing Research Council has provided which enabled us to complete this study.


Mae Chan,Theresa Wang, Nancy Woodward, Esther Nickols

Mei Chan, RN; Theresa Wang, BSN, RN, CCRN; Nancy Woodward, MS, RN, CNS, CWON; Esther Nickols, BSN, RN, CCRN

PICO Question: "Will the addition of a prophylactic dressing in high risk critical care patients in the CCU and throughout their stay combined with an existing pressure ulcer prevention bundle significantly reduce the incidence of sacral and coccygeal pressure ulcers in these patients?"

The Pressure Ulcer Prevention committee has instituted many changes in the prevention program which have helped to reduce the incidence of pressure ulcers including implementation of new support surfaces, weekly wound rounds, changes in medical devices, classes and in-services. A review of last year showed our pressure ulcers were primarily on the sacrum and coccyx, and most correlated with having spent time in critical care. This study looked at adding a silicone sacral dressing to the existing bundle of preventive care for CCU high-risk patients to reduce skin trauma, protect from friction, shear, and maceration of skin.

Staff worked together as a team to identify high-risk patients based on specific criteria, implement the HAPU prevention bundle, place the sacral dressing, and lift it for daily skin inspections, and replace it every three days based on the study protocol for the duration of the entire hospital length of stay. The support of the Nursing Research council and the involvement of the entire CCU staff as well as strong Management support have made this a successful and very satisfying project and resulted in a significant decrease in sacral HAPUs.

As a result of the statistically significant findings, a practice change throughout the hospital has resulted in a decrease in HAPU,s and many at-risk patients from units other than the CCU are benefiting, as shown a continued reduction in pressure ulcers. Data analysis examined high-risk CCU patients and led to suggestions for further interventions for CCU and other patients.


Christine Reich and Bonnie Gebhart.jpg

Christine Reich, BSN, RN-BC, and Bonnie Gebhart, MBA, BSN, RN-BC

PICO Question: "Does weekly motivational counseling influence readiness to change in female health care workers, aged 40-65 who have at least one risk factor for heart disease?"

57 participants completed our study, and their greatest cardiovascular risks were being overweight/obesity, stress and lack of regular exercise. Measures in the readiness to change ruler did not differ significantly between groups. The intervention group had more weight loss, stress reduction and days of exercise. We concluded that participants responded to motivational counseling and the readiness to change ruler is a useful preassessment tool for commitment to make change. Ongoing evaluation of strategies to assist healthcare providers to reduce cardiovascular risk remains an important area of study.

We would like to thank H2H for their generous grant to fund this research. We were grateful for the opportunity to be involved in this primary research project and to be able to make a difference in the lives of many women at El Camino Hospital.